San Joaquin County hospital operates at nearly $30 million deficit

San Joaquin County General Hospital operated at a $27 million deficit in January and that's expected to grow to $32 million by June 30.

Hospital administrators and consultants painted a bleak financial picture at Tuesday's Board of Supervisors meeting, and supervisors were left scratching their heads at finding a solution for the problem.

The hospital has a total budget of around $200 million, according to county budget documents.

San Joaquin General primarily serves the indigent — people who don't have health insurance. But Camden Group, an El Segundo consulting firm, suggested the Board of Supervisors consider expanding the county hospital's services to attract insured patients.

An "indigent" person is defined as making less than 300 percent of the federal poverty level, which is currently $56,556 for a family of four. To be eligible as an indigent, patients' assets may not exceed $10,000 aside from their primary residence and one car, and they must be a county resident for at least 30 days.

Supervisor Larry Ruhstaller blames the state for not helping the county financially.

"The state is basically trying to make the county indigent," Ruhstaller said.

The board was also given options ranging from investing in greater services to seek a greater payback, cutting it down to a bare-bones operation or to keep things pretty much the way it is.

Supervisor Leroy Ornellas said he wants more options on the table — including closing down the county hospital altogether.

Supervisor Ken Vogel, who represents the Lodi area, asked Camden Group representatives whether they had thought about establishing community clinics. Santa Clara County has used the community clinic program to get more people to use its county hospital when the need arises, Vogel said.

Supervisor Victor Mow suggested asking chief administrative officers and medical directors at Lodi Memorial and other hospitals to brainstorm what can be done about the county's situation with its hospital.

Options for San Joaquin General

Maintain the current volume of 100 to 120 patients per day. That would require reducing staff by the equivalent of 100 full-time employees and recruiting strong internal management staff.

Increase operations to 120 to 140 patients per day. That would require more paying customers, recruiting community primary care and specialty physicians, add services like surgery, anesthesia, trauma and primary care, increase the emergency room capacity. This options requires substantial money and may be risky because the hospital may not be successful at increasing the number of patients.

Substantially downsize the hospital to serving only 60 to 80 patients per day. That would require reducing staff by the equivalent of 300 employees, closing the pediatric unit, eliminating the medical residency program or relocating it to another hospital, move patients to other area providers and affiliate with community clinics so that the hospital wouldn't need to serve non-urgent ambulatory patients.

Contract or partner with private entities like Sutter, Tenet and children's hospitals or public institutions like hospitals run by University of California campuses in Davis and San Francisco.

New revenue sources like a parcel tax, sales tax or developer fees.

Source: The Camden Group

Mow added that he wants to find out how important San Joaquin General is to the other hospitals in the county, including whether they would be willing to contribute money toward the county's operations to serve the uninsured.

Between the hospital and new county jail that is under construction, Mow said, the county faces $65 million to $70 million in annual operating costs that it doesn't have.

San Joaquin General is very important to the Board of Supervisors, patients and the county's economy, Vogel said.

Closing the hospital altogether is not a real option, since San Joaquin County is one of only 13 of the 58 counties in California to operate a general acute-care hospital, according to The Camden Group.

Counties like Sacramento, Orange and San Diego have agreements with the University of California system and other community hospitals, according to the report. To the south, Stanislaus County has a long-term agreement with Tenet HealthCare, a for-profit system.

San Joaquin General isn't competitive with other hospitals in the county because Stockton and Tracy hospitals have increased their share of Medi-Cal Managed Care patients over the last four years, according to the consultant's report. Additionally, the county hospital lacks services used by older and "baby boom" patients, such as cardiac and comprehensive cardiac care, the Camden Group reported.

In addition to thoroughly examining San Joaquin General's finances and operations, The Camden Group has also been the hospital's interim managers. Since Oct. 15, David Culbertson doubles as a Camden Group vice president and interim CEO of the county hospital. Erlinda Bolor, also from Camden, is interim chief nursing officer, and Brian Eisenberg has been chief financial officer since Feb. 11.

The Board of Supervisors didn't make any decisions on Tuesday.

Contact reporter Ross Farrow at rossf@lodinews.com.

Reader Feedback

Comments on this story are now closed.

Archives

Story Tools

Indexes